Provider Demographics
NPI:1366591729
Name:LIU, WENHUA
Entity type:Individual
Prefix:
First Name:WENHUA
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 HUNTER RD
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1460
Mailing Address - Country:US
Mailing Address - Phone:773-358-0180
Mailing Address - Fax:
Practice Address - Street 1:28100 N ASHLEY CIR STE 106
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-9478
Practice Address - Country:US
Practice Address - Phone:847-996-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01071883A207ZP0102X
IL036-113331207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-113331OtherMEDICAL LICENSE
IL363488183006Medicaid